1. MAINTENANCE OF CERTIFICATION Part IV Practice Performance and Improvement David L. Gillespie MD, FACS Professor of Surgery University of Rochester School of Medicine and Dentistry Rochester, NY

2. The American Board of Surgery Maintenance of Certification ongoing process ongoing process continuous improvement continuous improvement Surgeons must demonstrate a program of Surgeons must demonstrate a program of  ongoing learning  professional assessment  self improvement Facilitates maintaining expertise within specialty Facilitates maintaining expertise within specialty

3. The American Board of Surgery Maintenance of Certification patient centered initiative patient centered initiative demonstrate high degree of professionalism demonstrate high degree of professionalism improve patient care improve patient care address concerns of public about quality address concerns of public about quality will strengthen the value of Board certification will strengthen the value of Board certification

4. The American Board of Surgery Maintenance of Certification (“MOC”): Maintenance of Certification (“MOC”): 1) Demonstration of Current Professional Standing 1) Demonstration of Current Professional Standing every 3 years, unrestricted License, privileges to practice, letter of attestationevery 3 years, unrestricted License, privileges to practice, letter of attestation 2) Demonstration of Lifelong Learning and Self Assessment 2) Demonstration of Lifelong Learning and Self Assessment 50 CME credits per year, demonstrate self assessment50 CME credits per year, demonstrate self assessment 3) Demonstration of Cognitive Expertise 3) Demonstration of Cognitive Expertise recertification examination, once every TEN (10) years.recertification examination, once every TEN (10) years. 4) Evaluation and Improvement of Performance in Practice 4) Evaluation and Improvement of Performance in Practice

5. The American Board of Surgery Maintenance of Certification (“MOC”): Maintenance of Certification (“MOC”): 1) Demonstration of Current Professional Standing 1) Demonstration of Current Professional Standing every 3 years, unrestricted License, privileges to practice, letter of attestationevery 3 years, unrestricted License, privileges to practice, letter of attestation 2) Demonstration of Lifelong Learning and Self Assessment 2) Demonstration of Lifelong Learning and Self Assessment 50 CME credits per year, demonstrate self assessment50 CME credits per year, demonstrate self assessment 3) Demonstration of Cognitive Expertise 3) Demonstration of Cognitive Expertise recertification examination, once every TEN (10) years.recertification examination, once every TEN (10) years. 4) Evaluation and Improvement of Performance in Practice 4) Evaluation and Improvement of Performance in Practice

6. The American Board of Surgery Maintenance of Certification (“MOC”): Maintenance of Certification (“MOC”): 1) Demonstration of Current Professional Standing 1) Demonstration of Current Professional Standing every 3 years, unrestricted License, privileges to practice, letter of attestationevery 3 years, unrestricted License, privileges to practice, letter of attestation 2) Demonstration of Lifelong Learning and Self Assessment 2) Demonstration of Lifelong Learning and Self Assessment 50 CME credits per year, demonstrate self assessment50 CME credits per year, demonstrate self assessment 3) Demonstration of Cognitive Expertise 3) Demonstration of Cognitive Expertise recertification examination, once every TEN (10) years.recertification examination, once every TEN (10) years. 4) Evaluation and Improvement of Performance in Practice 4) Evaluation and Improvement of Performance in Practice

7. The American Board of Surgery Maintenance of Certification (“MOC”): Maintenance of Certification (“MOC”): 1) Demonstration of Current Professional Standing 1) Demonstration of Current Professional Standing every 3 years, unrestricted License, privileges to practice, letter of attestationevery 3 years, unrestricted License, privileges to practice, letter of attestation 2) Demonstration of Lifelong Learning and Self Assessment 2) Demonstration of Lifelong Learning and Self Assessment 50 CME credits per year, demonstrate self assessment50 CME credits per year, demonstrate self assessment 3) Demonstration of Cognitive Expertise 3) Demonstration of Cognitive Expertise recertification examination, once every TEN (10) years.recertification examination, once every TEN (10) years. 4) Evaluation / Improvement of Practice Performance 4) Evaluation / Improvement of Practice Performance

8. The American Board of Surgery Part IV MOC Practice Performance and Improvement Verification required every three (3) years Verification required every three (3) years involved in one or more assessment programs involved in one or more assessment programs focus on analysis of practice performance focus on analysis of practice performance quantitative assessment quantitative assessment Use info gained for performance improvement Use info gained for performance improvement

9. The American Board of Surgery Requirements are subject of active discussion Requirements are subject of active discussion  by the ABS, ACS, SVS, SCVS unclear what programs will qualify unclear what programs will qualify  To show Performance Evaluation/Improvement will be more than participation in M&M will be more than participation in M&M Part IV MOC Practice Performance and Improvement

10. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – Some examples which might apply include Some examples which might apply include  participation in Quality Outcome projects such as National Surgical Quality Improvement Project (NSQIP),National Surgical Quality Improvement Project (NSQIP), Surgical Care Improvement Project (SCIP)Surgical Care Improvement Project (SCIP)  practice databases such as those being developed through the ACS web portalthe ACS web portal the SVS carotid databasethe SVS carotid database

11. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – Participation in NSQIP (National Surgery Quality Improvement Program) Participation in NSQIP (National Surgery Quality Improvement Program)

12. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – NSQIP (National Surgery Quality Improvement Program) NSQIP (National Surgery Quality Improvement Program)  Grew out of the National VA Surgical Risk Study 1991  now offered to all interested hospitals  2004 ACS began enrolling new private sector hospitals into the ACS NSQIPnew private sector hospitals into the ACS NSQIP

13. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – NSQIP (National Surgery Quality Improvement Program) NSQIP (National Surgery Quality Improvement Program)  The ACS NSQIP is available to all private sector hospitals that meet the minimum participation requirements,meet the minimum participation requirements, complete a hospital agreement,complete a hospital agreement, pay an annual fee of $35,000.pay an annual fee of $35,000.  Many benefits by participating most importantly reduction of surgical morbidity and mortalitymost importantly reduction of surgical morbidity and mortality  VA NSQIP will continue in parallel system will compare its results against the ACS NSQIP private sector datawill compare its results against the ACS NSQIP private sector data

14. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – Participation in SCIP (Surgical Care Improvement Project) Participation in SCIP (Surgical Care Improvement Project)

15. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – SCIP (Surgical Care Improvement Project) SCIP (Surgical Care Improvement Project)  A national quality partnership of organizations  improving surgical care by reducing surgical complications  Steering committee ACS, CMS, AHA, ASA, AORN, CDC, AHRQ  Goal: reduce preventable surgical M&M by 25 % by the 2010  Hospitals can join SCIP to collect and submit data  Hospitals that wish to sign up to participate in SCIP complete Hospital Letter of Participation and fax it complete Hospital Letter of Participation and fax it

16. The American Board of Surgery SCIP has four modules SCIP has four modules  Infection 7 Infection Prevention Process Measures7 Infection Prevention Process Measures  Venous Thromboembolus (VTE) 2 VTE Prevention Process Measures2 VTE Prevention Process Measures  Cardiac Prevention Module 1 Cardiovascular Prevention Measure1 Cardiovascular Prevention Measure  Respiratory Delayed implementation to use these measure in expanding the ICU Core Measure SetDelayed implementation to use these measure in expanding the ICU Core Measure Set Part IV MOC- Practice Performance and Improvement –

17. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – Some examples which might apply include Some examples which might apply include  participation in Quality Outcome projects such as National Surgical Quality Improvement Project (NSQIP),National Surgical Quality Improvement Project (NSQIP), Surgical Care Improvement Project (SCIP)Surgical Care Improvement Project (SCIP)  practice databases such as those being developed through the ACS web portalthe ACS web portal the SVS carotid database.the SVS carotid database.

18. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – ACS Practice Based Learning System (case log system) ACS Practice Based Learning System (case log system)

19. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – ACS case log system ACS case log system  allows surgeons to track their cases and outcomes  convenient easy-to-use.  Can compare personal outcomes to others confidentially  opportunities for training from learning modules

20. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – ACS case log system ACS case log system  The American Board of Surgery has identified Practice Based Learning and Improvement as a core competency.identified Practice Based Learning and Improvement as a core competency.  in the future the case logging system could support submission of case logs for maintenance of certification (MOC).submission of case logs for maintenance of certification (MOC).  open only to members of the American College of Surgeons.  To register for the system you will need to log in to the ACS Web site.

21. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – SVS carotid database SVS carotid database

22. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – SVS carotid database SVS carotid database  ensures eligibility for CAS reimbursement. CMS require data collection on CAS for reimbursementCMS require data collection on CAS for reimbursement  offers confidential benchmarking reports Site-specific CEA vs. CAS baseline risk factors and complicationsSite-specific CEA vs. CAS baseline risk factors and complications  over time in your facility.  to other institutions  by individual provider  "Real time" access to all your data for analysis.

23. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – SVS carotid database SVS carotid database  Facility benefits available nowavailable now easy-to-useeasy-to-use cost-effective way to meet CMS regulations for CAScost-effective way to meet CMS regulations for CAS downloadable databasedownloadable database Collection of ongoing follow-upCollection of ongoing follow-up Collects both stenting and open repair data for comparison.Collects both stenting and open repair data for comparison. Real-time comparative reports.Real-time comparative reports.  one-time enrollment fee of $1,000  annual subscription fee of $3,000

24. The American Board of Surgery Part IV MOC- Practice Performance and Improvement – The ABS is investigating other data systems The ABS is investigating other data systems  Personal  national,  regional,  hospital-specific and is soliciting input and is soliciting input e-mail at mocpart4@absurgery.org e-mail at mocpart4@absurgery.org

25. The American Board of Surgery